Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study

Breast Cancer Res Treat. 2016 Aug;159(1):119-29. doi: 10.1007/s10549-016-3913-x. Epub 2016 Jul 22.

Abstract

Breast cancer-related lymphedema (BCRL) is a serious chronic condition after breast cancer (BC) surgery and treatment. It is unclear if BCRL risk varies by race/ethnicity. In a multiethnic prospective cohort study of 2953 BC patients, we examined the association of self-reported BCRL status with self-reported race/ethnicity and estimated genetic ancestry. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated by multivariable Cox proportional hazards models, with follow-up starting 6 months post-BC diagnosis. Estimates were further stratified by body mass index (BMI). By 48 months of follow-up, 342 (11.6 %) women reported having BCRL. Younger age at BC diagnosis, higher BMI at baseline, and lower physical activity were associated with greater BCRL risk. African American (AA) women had a 2-fold increased risk of BCRL compared with White women (HR = 2.04; 95 % CI 1.35-3.08). African genetic ancestry was also associated with an increased risk (HR = 2.50; 95 % CI 1.43, 4.36). Both risks were attenuated but remained elevated after adjusting for known risk factors and became more pronounced when restricted to the nonobese women (adjusted HR = 2.31 for AA and HR = 3.70 for African ancestry, both p < 0.05). There was also evidence of increased BCRL risk with Hispanic ethnicity in the nonobese women. Nonobese AA women had a higher risk of BCRL than White women, which cannot be fully explained by known risk factors. This is the first large-scale, prospective study demonstrating differences in BCRL risk according to race/ethnicity as assessed by both self-report and genetic ancestry data, with a potential ancestry-obesity interaction.

Keywords: Ancestry; Breast cancer-related lymphedema; Genetics; Interaction; Obesity; Racial disparity.

MeSH terms

  • Adult
  • Age of Onset
  • Aged
  • Black or African American / genetics*
  • Body Mass Index
  • Breast Cancer Lymphedema / epidemiology*
  • Breast Cancer Lymphedema / ethnology*
  • Breast Cancer Lymphedema / genetics
  • Female
  • Hispanic or Latino / genetics*
  • Humans
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Self Report
  • White People / genetics*